Healthcare systems (HSs) provide essential services to populations yet require a large amount of energy to perform duties and tasks. Specifically, 4.4% of global net carbon emissions can be attributed precisely to the activities of HSs. Therefore, it seems unlikely that the targets of zero carbon dioxide (CO₂) emissions by 2050, set by the Paris Agreement, will be met without rethinking the role and impact of HSs towards climate change. Here we summarize the available literature on CO₂ emissions depending on direct and indirect Hss activities. We show that the number of studies addressing this topic is still very limited and that most of the emissions derive from the supply chain HSs rely on to perform their tasks. Furthermore, we highlight how this topic is addressed unevenly among countries. Indeed, we found that less economically developed countries are less represented in the literature on this topic and that, even in economically developed countries, most of the studies come from English-speaking countries. In the discussion, we stress that health workers and policymakers should pay more attention to this issue in order to tackle climate change and related health issues, following the example of few virtuous countries. Finally, some potential impact mitigation strategies are discussed.

Current knowledge about the spread of pathogens in aquatic environments is scarce probably because bacteria, viruses, algae and their toxins tend to occur at low concentrations in water, making them very difficult to measure directly. The purpose of this study was the development and validation of tools to detect pathogens in freshwater systems close to an urban area. In order to evaluate anthropogenic impacts on water microbiological quality, a phylogenetic microarray was developed in the context of the EU project µAQUA to detect simultaneously numerous pathogens and applied to samples from two different locations close to an urban area located upstream and downstream of Rome in the Tiber River. Furthermore, human enteric viruses were also detected. Fifty liters of water were collected and concentrated using a hollow-fiber ultrafiltration approach. The resultant concentrate was further size-fractionated through a series of decreasing pore size filters. RNA was extracted from pooled filters and hybridized to the newly designed microarray to detect pathogenic bacteria, protozoa and toxic cyanobacteria. Diatoms as indicators of the water quality status, were also included in the microarray to evaluate water quality. The microarray results gave positive signals for bacteria, diatoms, cyanobacteria and protozoa. Cross validation of the microarray was performed using standard microbiological methods for the bacteria. The presence of oral-fecal transmitted human enteric-viruses were detected using q-PCR. Significant concentrations of Salmonella, Clostridium, Campylobacter and Staphylococcus as well as Hepatitis E Virus (HEV), noroviruses GI (NoGGI) and GII (NoGII) and human adenovirus 41 (ADV 41) were found in the Mezzocammino site, whereas lower concentrations of other bacteria and only the ADV41 virus was recovered at the Castel Giubileo site. This study revealed that the pollution level in the Tiber River was considerably higher downstream rather than upstream of Rome and the downstream location was contaminated by emerging and re-emerging pathogens.

Microbiological indicators are commonly used in the assessment of public health risks associated with fecal contamination of freshwater ecosystems. Sediments are a reservoir of microorganisms, and can thus provide information on past pollution events, not obtainable through the testing of surface water. Moreover, pathogens present in sediment may represent future threats to human health. Clostridium perfringens, a typical colonizer of sediments, has been suggested as an alternative indicator of fecal pollution. In order to be suitable for such purpose, the microorganism should be widely distributed in contaminated environments. The objective of this study was thus to determine the composition of the anaerobic community in sediment samples of the lower Tiber basin, in central Italy, through a combined approach involving granulometric analysis of sediment samples, as well as a microbiological and molecular (16S rRNA) analysis of strains.

Climatic changes are associated with heat waves, droughts, and floods which have significant impacts on human health. Floods enhance the effects of water-borne pathogens increasing the concentration of biological agents in surface water. On the basis of national statistics collected by the Italian Ministry of Health, this work illustrates preliminary observations concerning outbreaks of water-borne diseases after flood events in Italy and presents options for an administrative response. The water-borne infectious diseases taken into account are Legionellosis, Salmonellosis, Hepatitis A, cutaneous and visceral Leishmaniasis, Leptospirosis, and Infectious Diarrhea. An association between these infectious diseases and flood events seems to exist in Italy, although further analysis should be carried out to confirm this relationship. Flood impacts can be distinguished into: immediate, medium term, and long term. Several factors are involved in determining the intensity and the severity of effects. Some vector-borne infectious diseases are likely to become more frequent due to changes in vector distribution and lifecycle dynamics associated with climate change. Health care systems should develop new strategies for a more comprehensive understanding of the impact of changing weather conditions on human health.

In conclusion, black flies can be considered good environmental indicators to assess ecological health of both watercourses and surrounding landscapes.

Chemical pollution, i.e. the release of anthropogenic chemical substances into the environment, is a driver of biodiversity loss. Although this issue has been widely investigated in high-income countries of temperate regions, there is a lack of data for tropical areas of middle- or low-income countries, such as those in Eastern Africa. Some of the world’s richest biomes that are affected by multiple pressures, including chemical pollution, are hosted in this macro-region. However, few studies have addressed the impact of the release of anthropogenic chemical pollutants on the biodiversity, and the related potential implications for the deterioration of ecosystem goods and services in this area. A contribution in systemising the scientific literature related to this topic is, therefore, urgently needed. We reviewed studies published from 2001 to 2021, focusing on the chemical pollution impact on Eastern African wildlife. Despite an extensive literature search, we found only 43 papers according to our survey methods. We focused on wildlife inhabiting terrestrial ecosystems and inland waters. According to our search, Kenya and Uganda are the most represented countries accounting for about half of the total number of reviewed articles. Moreover, 67.4% of the studies focus on inland waters. The spread of anthropogenic chemicals into tropical areas, e.g. Eastern Africa, and their effects on living organisms deserve greater attention in research and politics. We report a weak increasing trend in publishing studies addressing this topic that might bode well. The combined effort of science and governments is crucial in improving the management of chemical pollutants in the environment for achieving the goals of biodiversity conservation.Significance: Chemical pollution represents an underestimated risk for the health of tropical ecosystems in middle- and low-income countries, such as those of Eastern Africa. There is a lack of data on chemical pollution effects on wildlife of Eastern African biomes. The anthropogenic release of chemical substances affects the health of biodiversity and humans, negatively influences ecosystem services in Eastern Africa, and makes conservation and protection measures less effective. There is an urgent need for improving research on chemical pollution effects and promoting a sustainable use of natural resources in Eastern Africa along with better management of farming and mining activities.